Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Urban Health. 2018 Jun;95(3):361-371. doi: 10.1007/s11524-018-0260-8.
Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81-7.49; non-gun OR = 1.59, 95% CI 0.54-4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34-2.44; non-gun OR = 1.96, 95% CI 0.73-5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36-11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48-12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to better safeguard adolescents.
在资源匮乏的城市社区中，急需采取以优势为基础的策略来减少青少年暴力行为。支持性的青少年与成年人的关系可能会提供保护，但这些研究受到自我报告的综合结果的限制。我们在资源匮乏的社区中对 10 至 24 岁的男性进行了一项基于人群的病例对照研究，以检验支持性成人联系与严重攻击伤害之间的关联。病例是来自两家一级创伤中心的枪击伤（n=143）和非枪击伤（n=206）的受害者。年龄和种族匹配的对照组（n=283）是从同一集水区使用随机数字拨号招募的。青少年与成年人的联系是通过以下两种方法定义的：（1）简短的调查问题和（2）详细的家庭系谱。分析采用条件逻辑回归。在具有较高既往暴力行为的青少年中，积极的成人联系，按照简短的调查问题定义，与枪击或非枪击攻击伤害之间没有显著关联（GSW OR=2.46，95%CI 0.81-7.49；非枪 OR=1.59，95%CI 0.54-4.67）或低既往暴力行为（GSW OR=0.92，95%CI 0.34-2.44；非枪 OR=1.96，95%CI 0.73-5.28）。相比之下，在具有较高既往暴力行为的青少年中，报告家庭系谱中有至少一个支持性成年家庭成员与枪击攻击伤害的可能性较高有关（OR=4.01，95%CI 1.36-11.80）和非枪击攻击伤害（OR=4.22，95%CI 1.48-12.04）。因此，我们无法证明在这种资源匮乏的环境中，积极的成人联系可以保护青少年男性免受严重的攻击伤害。然而，在受伤时，受攻击伤害的青少年，尤其是那些具有较高既往暴力行为的青少年，报告了高水平的家庭支持。受伤后时期可能提供了干预的机会，以加强和利用家庭联系，探讨如何更好地保护青少年。
